Intravascular sheath

Abstract

Surgical apparatus includes a tubular sheath having a lumen passing longitudinally therethrough. The sheath includes a flexible distal section, configured for percutaneous insertion into an artery of a patient and including radiopaque gradations to indicate a depth of penetration of the sheath into the artery and having a distal port communicating with the lumen, and a rigid proximal section. A hub connected to a proximal end of the proximal section includes first and second proximal ports communicating with the lumen, such that the first proximal port is coaxial with the sheath and the second proximal port is angled relative to the sheath.

The invention claimed is: 
     
         1 . Surgical apparatus, comprising:
 a tubular sheath having a lumen passing longitudinally therethrough and comprising:
 a flexible distal section configured for percutaneous insertion into an artery of a patient and comprising radiopaque gradations to indicate a depth of penetration of the sheath into the artery and having a distal port communicating with the lumen; and 
 a rigid proximal section; and 
   a hub connected to a proximal end of the proximal section and comprising first and second proximal ports communicating with the lumen, such that the first proximal port is coaxial with the sheath and the second proximal port is angled relative to the sheath.   
     
     
         2 . The apparatus according to  claim 1 , wherein the flexible distal section has a preformed angular bend. 
     
     
         3 . The apparatus according to  claim 1 , and comprising a dilator rod configured for insertion into the lumen through the first proximal port and terminating in a distal tip, which protrudes through the distal port into the artery when the dilator rod is fully inserted into the lumen. 
     
     
         4 . The apparatus according to  claim 1 , and comprising a fixation clip, which comprises:
 a collar configured to be fitted over the proximal section of the sheath in a desired location and to grasp the sheath at the desired location; and   one or more eyelets fixed to the collar and configured for passage of a suture therethrough so as to secure the fixation clip to skin of the patient.   
     
     
         5 . The apparatus according to  claim 1 , and comprising a shunt tube for connection between the second proximal port and a venous sheath for insertion into a vein of the patient so as to convey a retrograde flow of blood from the artery to the vein through the sheath and the shunt tube. 
     
     
         6 . The apparatus according to  claim 1 , wherein the first proximal port comprises a luer fitting configured for connection of a valve thereto. 
     
     
         7 . The apparatus according to  claim 1 , wherein the radiopaque gradations comprise radiopaque bands extending circumferentially around the distal section at predefined intervals. 
     
     
         8 . The apparatus according to  claim 1 , wherein the radiopaque gradations comprise numbers. 
     
     
         9 . The apparatus according to  claim 1 , and comprising a stopper, which is configured to slide longitudinally along the distal section of the sheath to a desired location and to grasp the sheath at the desired location so as to limit a depth of penetration of the sheath into the artery. 
     
     
         10 . Surgical apparatus, comprising:
 a tubular sheath having a lumen passing therethrough and comprising a distal section configured for percutaneous insertion into an artery of a patient and a proximal section connected to the distal section; and   at least one fixation clip, which comprises:
 a collar configured to be fitted over the proximal section of the sheath in a desired location and to grasp the sheath at the desired location; and 
 one or more eyelets fixed to the collar and configured for passage of a suture therethrough so as to secure the fixation clip to skin of the patient. 
   
     
     
         11 . The apparatus according to  claim 10 , wherein the at least one fixation clip comprises multiple fixation clips, which are configured to be fitted over the proximal section of the sheath at different, respective locations. 
     
     
         12 . The apparatus according to  claim 11 , wherein the collar has a frictional inner surface to grip an outer surface of the sheath. 
     
     
         13 . A surgical method, comprising:
 inserting a flexible distal section of a tubular sheath percutaneously into an artery of a patient, the sheath having a lumen passing longitudinally therethrough, and the flexible distal section comprising radiopaque gradations; and   controlling a depth of penetration of the sheath into the artery by observing the radiopaque gradations in a fluoroscopic image.   
     
     
         14 . The method according to  claim 13 , wherein the sheath comprises a hub connected to a proximal end of the sheath, the hub comprising first and second proximal ports communicating with the lumen, such that the first proximal port is coaxial with the sheath and the second proximal port is angled relative to the sheath. 
     
     
         15 . The method according to  claim 14 , and comprising inserting a dilator rod into the lumen through the first proximal port so that a distal tip of the dilator rod protrudes through a distal port of the sheath into the artery when the dilator rod is fully inserted into the lumen. 
     
     
         16 . The method according to  claim 14 , and comprising:
 inserting a venous sheath into a vein of the patient; and   connecting a shunt tube between the second proximal port of the hub and the venous sheath so as to convey a retrograde flow of blood from the artery to the vein through the sheaths and the shunt tube.   
     
     
         17 . The method according to  claim 14 , wherein the first proximal port comprises a luer fitting configured for connection of a valve thereto. 
     
     
         18 . The method according to  claim 13 , and comprising fitting a fixation clip over a proximal section of the sheath in a desired location so that the clip grasps the sheath at the desired location, and securing the fixation clip to skin of the patient using a suture passed through one or more eyelets on the fixation clip. 
     
     
         19 . The method according to  claim 13 , wherein the radiopaque gradations comprise radiopaque bands extending circumferentially around the distal section at predefined intervals. 
     
     
         20 . The method according to  claim 13 , wherein the radiopaque gradations comprise numbers. 
     
     
         21 . The method according to  claim 13 , and comprising sliding a stopper longitudinally along the distal section of the sheath to a desired location and so that the stopper grasps the sheath at the desired location and limits a depth of penetration of the sheath into the artery. 
     
     
         22 . A surgical method, comprising:
 inserting a distal section of a tubular sheath percutaneously into an artery of a patient, the sheath having a lumen passing therethrough and comprising a proximal section connected to the distal section;   fitting at least one fixation clip over the proximal section of the sheath in a desired location so that the clip grasps the sheath at the desired location; and   securing the fixation clip to skin of the patient using a suture passed through one or more eyelets on the fixation clip.   
     
     
         23 . The method according to  claim 22 , wherein fitting the at least one fixation clip comprises fitting multiple fixation clips over the proximal section of the sheath at different, respective locations, for securing to the skin at the respective locations.